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Tuesday, February 8, 2011

MEDIAN NERVE PARALYSIS

The median nerve may be injure:
  • In the axilla, or above the elbow, although this is rare.
  • At the elbow, where it may be involved in a fracture, though far less frequently than the ulnar nerve.
  • Low in the forearm, or at the wrist, the most common site of injury, since the nerve is in a superficial position.
Symptoms and signs

a. In the forearm: There is paralysis of the pronators and flexor carpi ulnaris and one half of flexor digitorum profundus.
b. In the hand: The loss of the power of opposing the thumb to the other fingers. if injured below the point where the muscular branches are given off in the forearm, the only loss is that of the thenar muscles and lumbricals. The thumb lies back on the same plane as the fingers, The hand is supinated, and the wrist is slight extension.
c. Anaesthesia on the part
d. Loss of joint sense
e. Trophic changes

Splint: Knuckle binder splint

Physiotherapy
  • Massage
  • Active movements
  • Stimulation
Exercise re-education
1. Grasping and squeezing a rubber ball.
2. Closing the hand; then opening gently.
  • Touching the tip of each finger in turn with tip of thumb making circles.
  • Touching the second phalanx of each finger with tip of thumb.
  • Piano-playing movements of fingers.
  • Picking up and putting down Small objects like balls and coins.

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